Cancer and Female Sexual Function.

Sexual health is a concern that often goes unaddressed among female cancer survivors. Management of these issues depends upon the type of malignancy, stage and other tumor characteristics, treatment, and the history, concerns, and goals of the individual patient.

Chronic graft-versus-host disease. Part I: Epidemiology, pathogenesis, and clinical manifestations.

Chronic graft-versus-host disease is a major complication of allogeneic hematopoietic cell transplantation and a leading cause of long-term morbidity, nonrelapse mortality, and impaired health-related quality of life. The skin is commonly affected and presents heterogeneously, making the role of dermatologists critical in both diagnosis and treatment. In addition, new clinical classification and grading schemes inform treatment algorithms, which now include 3 U.S. Food and Drug Administration-approved therapies, and evolving transplant techniques are changing disease epidemiology. Part I reviews the epidemiology, pathogenesis, clinical manifestations, and diagnosis of chronic graft-versus-host disease. Part II discusses disease grading and therapeutic management.

Chronic graft-versus-host disease. Part II: Disease activity grading and therapeutic management.

Chronic graft-versus-host disease (cGVHD) is a major complication of allogeneic hematopoietic cell transplantation and a leading cause of long-term morbidity, nonrelapse mortality, and impaired health-related quality of life. The skin is commonly affected and presents heterogeneously, making the role of dermatologists critical in both diagnosis and treatment. In addition, new clinical classification and grading schemes inform treatment algorithms, which now include 3 Federal Drug Administration-approved therapies, and evolving transplant techniques are changing disease epidemiology. Part I reviews the epidemiology, pathogenesis, clinical manifestations, and diagnosis of cGVHD. Part II discusses disease grading and therapeutic management.

Sexual Health Issues in Cancer Survivors.

OBJECTIVE: To review the sexual health issues cancer survivors may experience, including incidence, association with treatment modalities, and approach to evaluation and treatment. DATA SOURCES: Peer-reviewed journal articles, medical society or government Web sites. CONCLUSION: Cancer diagnosis and treatment often impacts sexual function and addressing this is a key component of health-related quality of life. IMPLICATIONS FOR NURSING PRACTICE: Screening, evaluation, and treatment of sexual dysfunction should be incorporated into routine oncologic care.

Vaginal Health During Breast Cancer Treatment.

There are increasing numbers of breast cancer survivors. Chemotherapy or endocrine therapy result in effects on vaginal health that may affect quality of life. These effects may impact sexual function, daily comfort, or the ability to perform a pelvic examination. Vulvovaginal atrophy, or genitourinary syndrome of menopause, may be treated with nonhormonal or hormonal measures. Breast cancer survivors who are menopausal and/or on endocrine therapy should be screened for issues with vaginal health and counseled about treatment options.

Managing premature menopause and sexual dysfunction.

PURPOSE OF REVIEW: Young women (<45 years of age) diagnosed with breast cancer face increased risk of sexual dysfunction as a result of their cancer-directed treatment. We will review the recent literature examining this critical challenge and discuss current efforts to address sexual dysfunction. RECENT FINDINGS: In the period since 2013, the literature has focused on sexual issues that result from the premature onset of menopausal symptoms and changes in sexual health following breast surgery. The impact of premature menopause in young women with breast cancer is profound and can affect all aspects of the sexual experience, from desire to function, and quality of life. Furthermore, the surgical treatment of breast cancer also has significant implications with respect to sexual desire and body image. There is a paucity of sexual health intervention for this population, though recent efforts suggest that sexual health outcomes may be improved if women are offered the appropriate intervention opportunities. However, the sexual function of young breast cancer patients is an under-discussed and under-treated health issue that warrants greater research and clinical focus. SUMMARY: Further intervention trials must be completed in this population of young women for whom sexual function plays such a critical role in their personal and relationship well being.

Sexual dysfunction in women with cancer.

Approximately 14 million people have a history of cancer in the United States alone, and the number is expected to increase with time. This has prompted an appreciation of the quality of life for survivors. Women treated for cancer identify gynecologic issues as a major concern for both general health and the negative impact on sexual function that follow the cancer diagnosis and subsequent treatment. Unfortunately, issues related to sexual health continue to be underappreciated. Although comprehensive cancer centers have adopted specialized centers for survivorship issues, including those involving sexual health, consultations are not widely available in most communities. We provide background information on female sexual health, examine the impact of cancer treatment on sexual function, and discuss some of the major sexual health issues of women who have received a cancer diagnosis and been subsequently treated.

Expectant management in spontaneous preterm premature rupture of membranes between 14 and 24 weeks' gestation.

OBJECTIVE: To examine maternal and neonatal outcomes in expectant management of spontaneous preterm premature rupture of membranes (PPROM) before 24 weeks. STUDY DESIGN: Patients presenting with spontaneous PPROM from 14 to 23 completed weeks' gestation between January 1, 1995 and December 31, 1999 were reviewed. A total of 108 pregnancies were evaluated; 57 patients elected expectant management. RESULTS: Median latency from rupture of membranes (ROM) to delivery was 6 days; the overall survival rate was 26.3%. In ROM <20 weeks, a twin and a triplet pregnancy with loss of the presenting fetuses yielded the only survivors. In patients with ROM from 20 to 21 and 22 to 23 weeks, survival rates were 2/16 (12.5%) and 11/20 (55.0%), respectively. In all, 18/57 (31.6%) of patients developed chorioamnionitis. There was no maternal sepsis or death. There were three cases of pulmonary hypoplasia, all in patients with ROM <20 weeks. CONCLUSIONS: Neonatal survival in spontaneous PPROM before 20 weeks is rare, irrespective of latency from ROM to delivery. When PPROM occurs from 20 to 24 weeks, survival improves with increasing gestational age at ROM and at delivery.